Provider Demographics
NPI:1891751772
Name:RUBIO, RAUL ERNESTO SR (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:ERNESTO
Last Name:RUBIO
Suffix:SR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 S MERCY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0425
Mailing Address - Country:US
Mailing Address - Phone:480-955-0900
Mailing Address - Fax:480-955-0800
Practice Address - Street 1:3420 S MERCY RD STE 300
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0425
Practice Address - Country:US
Practice Address - Phone:480-955-0900
Practice Address - Fax:480-955-0800
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7764363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ147434Medicaid